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General NPI Number Information
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NPI Number | 1356141154
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Entity Type | Organization
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Legal Business Name | CEREBRUM EXPLORATION COUNSELING, LICENSED CLINICAL SOCIAL WORKER CORP
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Dates
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Enumeration Date | 03/19/2025
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 23161 MILL CREEK DR STE 315
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-7907
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Country | US
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Telephone | 818-445-0952
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Fax | 949-368-9843
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Provider Business Mailing Address
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Address Line | 2102 BUSINESS CENTER DR # 2010
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City | IRVINE
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State | CA
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Zip | 92612-1001
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Country | US
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Telephone | 818-445-0952
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Fax | 949-209-4965
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | GLADYS Y NEWBURY
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Credential | LCSW
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Telephone | 818-445-0952
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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